A Comparative Efficacy of Propacetamol and Ketorolac in Postoperative Patient Controlled Analgesia

Abstract

BackgroundKetorolac has been used as a postoperative analgesia in combination with opioids. However, the use of ketorolac may produce serious side effects in vulnerable patients. Propacetamol is known to induce fewer side effects than ketorolac because it mainly affects the central nervous system. We compared the analgesic effects and patient satisfaction levels of each drug when combined with fentanyl patient-controlled analgesia (PCA).MethodsThe patients were divided into two groups, each with n = 46. The patients in each group were given 60 mg of ketorolac or 2 g of propacetamol (mixed with fentanyl) for 10 minutes. The patients were then given 180 mg of ketorolac or 8 g of propacetamol (mixed with fentanyl and ramosetron) through PCA. We assessed the visual analogue pain scale (VAS) at the time point immediately before administration (baseline) and at 15, 30, and 60 minutes, and 24 hours after administration. Also, the side effects of each regimen and each patient's degree of satisfaction were assessed.ResultsThere was a significant decline in the VAS score in both groups (P < 0.05). However, there were no significant differences in the VAS scores between the groups at each time point. Satisfaction scores between the groups showed no significant difference.ConclusionsThe efficacy of propacetamol is comparable to that of ketorolac in postoperative PCA with fentanyl.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

“…Varrassi et al [26] There was no significant difference between the groups in development of vomiting, dizziness, and headache within 24 hours after surgery and none of the patients developed pruritus. These findings were also correlated to the findings of the previous study [20]. Although the development of nausea was not significantly different between the groups when analyzed at each detection time, the overall number of patients who experienced nausea was greater in group P than in group K, with statistical significance.…”

“…The suggested minimum sample size was 53 per group at the level of power = 0.8, α = 0.05, and effect size of 1.2, which was estimated from a previous study [20]. Considering dropouts and failures, 60 subjects (14% was added)…”

Pre-Emptive Effect of Intravenous Paracetamol Versus Intravenous Ketorolac on Post-Operative Pain and Shivering After Septoplasty Under General Anesthesia: A Comparative Study

“…Despite the relatively low dose of propacetamol, as compared to that of ketorolac, the analgesic efficacy of the propacetamol group was comparable to that of the ketorolac group in postoperative patients using patient-controlled analgesia with fentanyl. This suggests that propacetamol is effective when used for the management of postoperative pain and combined with fentanyl PCA 21 .…”

Microbiological and Physicochemical Stability of Fentanyl, Oxycodone, Hydromorphone, Ketorolac, Ramosetron, and Ondansetron for Intravenous Patient-controlled Analgesia: An In Vitro Study

“…Stability of Mixtures for Intravascular Patient-Controlled Analgesia effects is reduced and the analgesic effect is increased when nonsteroidal anti-inflammatory drugs are used for multimodal PCA (11,13,35). Incorporating antiemetics into IV PCA is a common approach (14)(15)(16).…”

“…Oxycodone and hydromorphone have a relatively long onset time and duration of action. The addition of ketorolac, a nonsteroidal anti-inflammatory drug (11)(12)(13), reduces the use and side effects of opioids. Antiemetic agents, such as ondansetron or ramosetron, can be added to IV PCA to reduce postoperative nausea and vomiting (14)(15)(16).…”